Herbal composition for the treatment of headache

ABSTRACT

Provided herein are custom therapeutic compositions combining select Chinese herbs and strains of Cannabis, methods of making the compositions, and methods of using the composition for treatment of headache pain.

CROSS-REFERENCE TO RELATED APPLICATIONS

This application claims the benefit of U.S. Provisional Patent Application No. 62/831,864, filed Apr. 10, 2019, which is incorporated by reference herein in its entirety.

BACKGROUND

The World Health Organization's (WHO) Atlas of Headache Disorders states that roughly 47% of the global population has some form of current headache disorder, meaning they have been symptomatic at least once in the last year (World Health Organization, 2011). Headache is also an expensive illness, with sufferers afflicted not only by pain but also decreased productivity, days lost from work, and hospital visits (Edmeads and Mackell 2002). It is estimated that $14.4 billion dollars are lost each year due to decreased quality of life and disability due to headaches (Lochte 2017).

The most common treatment for tension-type headache are over-the-counter (OTC) analgesic drugs, including aspirin, acetaminophen and ibuprofen. These drugs all function similarly for the episodic treatment of headache by irreversibly binding to cyclooxygenase-1 (COX-1) and cyclooxygenase-2 (COX-2) enzymes. By inhibiting these enzymes' function, inflammation and pain-inducing prostaglandins cannot be synthesized. Lowered prostaglandin levels lead to a decrease in pain and headache (Macdonald 2013). However, the American Association of Family Practitioners (AAFP) recommends that these drugs not be used more than twice weekly, as rebound headache can occur (Millea 2002). A rebound headache results from decreasing analgesic drug concentration in the body. This also may be associated with nausea, poor appetite, irritability and poor concentration (Rapoport, 1996). Furthermore, drugs like acetaminophen and ibuprofen can have major side effects ranging from liver and kidney damage (Plaisance, 2000), to the recently discovered deleterious effects of these drugs on human fetal sex germ cells (Hurtado-Gonzalez, 2018).

Chinese herbal medicine has been shown to be effective for the treatment of tension type headache. However, the amount of peer-reviewed literature is limited in its scope and scientific rigor. For example, in most studies researching the efficacy of Chinese herbal medicine (CHM) for headache, classical pattern diagnosis and differentiation is not a major component of prescription. Cannabis indica has similarly been included in many European and North American pharmacopeias for the treatment of migraine headache. However, due to persistent legal constraints, there is a paucity of peer-reviewed studies of Cannabis pharmacology as it pertains to headache treatment, and those that exist are limited in scope.

Thus, there remains a need for the identification of reproducible, therapeutically-effective compositions and methods comprising Cannabis and Chinese herbs that deliver persistent headache abatement without the unintended side effects of over-the-counter options.

SUMMARY

In one aspect, a composition is provided comprising therapeutically effective amounts of Cannabis and the herbs Corydalis yanhusuo, Paeonia lactiflora, Ligusticum chuangxiong, Angelica dahurica, and Scutellaria baicalensis, wherein the therapeutically effective amounts ameliorate or prevent symptoms associated with headache. In some embodiments, the composition further comprises the herbs Mentha Haplocalyx, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora. The mass ratio of Corydalis yanhusuo:Scutellaria baicalensis:Ligusticum chuangxion:Mentha Haplocalyx:Angelica dahurica:Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum:Paeonia lactiflora is about 12:8:12:24:6:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15:12. In an embodiment, the composition comprises an emulsification of (a) an oil extract of the Cannabis and (b) an aqueous ethanol extract of the herbs. In some embodiments, the aqueous ethanol extract of the herbs is an extract of an herb blend comprising a ratio of the herbs described herein.

In another aspect a method of forming a composition is provided, the method comprising Cannabis and two or more herbs selected from the group consisting of Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and combinations thereof; the method comprising: extracting the Cannabis with oil, extracting the two or more herbs with aqueous ethanol, and emulsifying the Cannabis extract with the extract of the two or more herbs.

In another aspect, a method of treating or preventing a headache symptom in a subject in need thereof is provided, the method comprising administering to the subject a therapeutically effective amount of a composition comprising an emulsification of (a) an oil extract of Cannabis and (b) an aqueous ethanol extract of two or more herbs selected from the group consisting of Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and combinations thereof. In an embodiment, the aqueous ethanol extract is of a blend of all of the herbs in a ratio described herein.

BRIEF DESCRIPTION OF THE DRAWINGS

FIG. 1: A table of the common types of cannabinoids is provided.

FIG. 2: A table of the common types of terpenes found in Cannabis is provided.

FIG. 3: A table of constituent herbs included in certain embodiments of the composition is provided.

FIG. 4: A schematic illustrating the method of forming the composition described herein, according to some embodiments.

DETAILED DESCRIPTION

The following terms are used throughout as defined below.

As used herein and in the appended claims, singular articles such as “a” and “an” and “the” and similar referents in the context of describing the elements (especially in the context of the following claims) are to be construed to cover both the singular and the plural, unless otherwise indicated herein or clearly contradicted by context. Recitation of ranges of values herein are merely intended to serve as a shorthand method of referring individually to each separate value falling within the range, unless otherwise indicated herein, and each separate value is incorporated into the specification as if it were individually recited herein. All methods described herein can be performed in any suitable order unless otherwise indicated herein or otherwise clearly contradicted by context. The use of any and all examples, or exemplary language (e.g., “such as”) provided herein, is intended merely to better illuminate the embodiments and does not pose a limitation on the scope of the claims unless otherwise stated. No language in the specification should be construed as indicating any non-claimed element as essential.

As used herein, “about” and “substantially” will be understood by persons of ordinary skill in the art and will vary to some extent depending upon the context in which it is used. If there are uses of the term which are not clear to persons of ordinary skill in the art, given the context in which it is used, “about” and “substantially” will mean up to plus or minus 10% of the particular term.

As will be understood by one skilled in the art, for any and all purposes, particularly in terms of providing a written description, all ranges disclosed herein also encompass any and all possible subranges and combinations of subranges thereof. Any listed range can be easily recognized as sufficiently describing and enabling the same range being broken down into at least equal halves, thirds, quarters, fifths, tenths, etc. As a non-limiting example, each range discussed herein can be readily broken down into a lower third, middle third and upper third, etc. As will also be understood by one skilled in the art all language such as “up to,” “at least,” “greater than,” “less than,” and the like include the number recited and refer to ranges which can be subsequently broken down into subranges as discussed above. Finally, as will be understood by one skilled in the art, a range includes each individual member. Thus, for example, a group having 1-3 atoms refers to groups having 1, 2, or 3 atoms. Similarly, a group having 1-5 atoms refers to groups having 1, 2, 3, 4, or 5 atoms, and so forth.

As used herein, the terms “subject,” “individual,” or “patient” can be an individual organism, a vertebrate, a mammal, or a human. “Mammal” includes a human, non-human primate, murine (e.g., mouse, rat, guinea pig, hamster), ovine, bovine, ruminant, lagomorph, porcine, caprine, equine, canine, feline, avis, etc. In any embodiment herein, the mammal is feline or canine. In any embodiment herein, the mammal is human.

The term “administering” a composition to a subject means delivering the composition to the subject. “Administering” includes prophylactic administration of the composition (i.e., before the headache and/or one or more symptoms of the headache are detectable) and/or therapeutic administration of the composition (i.e., after the headache and/or one or more symptoms of the headache are detectable). The methods of the present technology may include administering one or more compounds, compositions or agents. If more than one compound, composition or agent is to be administered it may be administered together at substantially the same time, and/or be administered before, concomitantly with, and/or after administration of another composition or therapeutic procedure (e.g., accupuncture).

As used herein, the terms “effective amount” or “therapeutically effective amount,” refer to a quantity sufficient to achieve a desired therapeutic and/or prophylactic effect, e.g., an amount which results in the full or partial amelioration of disorders or symptoms, e.g., those associated with headache in a subject in need thereof. In the context of therapeutic or prophylactic applications, the amount of a composition administered to the subject will depend on the type and severity of the disorder or symptom and on the characteristics of the individual, such as general health, age, sex, body weight and tolerance to drugs or herbs. It will also depend on the degree, severity and type of disorder or symptom. The skilled artisan will be able to determine appropriate dosages depending on these and other factors. The compositions can also be administered in combination with one or more additional compounds, compositions, or herbs. In some embodiments, multiple doses are administered. Additionally or alternatively, in some embodiments, multiple therapeutic compositions or compounds are administered. In the methods described herein, the compositions may be administered to a subject having one or more signs or symptoms of a disorder described herein.

“Treating,” “treat,” “treated,” or “treatment” as used herein covers the treatment of a disease or disorder described herein (e.g., headache), in a subject, such as a human, and includes: (i) inhibiting a disease or disorder, i.e., arresting its development; (ii) relieving a disease or disorder, i.e., causing regression of the disorder; (iii) slowing progression of the disorder; and/or (iv) inhibiting, relieving, ameliorating, or slowing progression of one or more symptoms of the disease or disorder. Symptoms may be assessed by methods known in the art or described herein, for example, quality of life questionnaires, patient-reported symptom scores, and imaging tests.

“Ameliorate,” “ameliorating,” and the like, as used herein, refer to inhibiting, relieving, eliminating, or slowing progression of one or more symptoms.

As used herein, “prevention,” “prevents,” or “preventing” of a disorder, symptom or condition refers to a composition that, in a statistical sample, reduces the occurrence of the disorder, symptom, or condition in the treated subject relative to a control subject, or delays the onset of one or more symptoms of the disorder or condition relative to the control subject.

Throughout this disclosure, various publications, patents and published patent specifications are referenced by an identifying citation. Also within this disclosure are referenced citations, the full bibliographic details of which are provided subsequent to the Examples section. The disclosures of these publications, patents, and published patent specifications are hereby incorporated by reference into the present disclosure to more fully describe the present technology.

1. Cannabis Pharmacology

The Cannabis plant is composed of hundreds of biologically active compounds (Backes 2014), including a large class of compounds called cannabinoids. The human body has an innate endocannabinoid system that plant-based phytocannabinoids can bind with and modulate. There are two major cannabinoids receptors in the body: CB1 which is located mostly in central and peripheral neurons and CB2 which is located mostly in immune cells. The major psychoactive compound in Cannabis is called delta-9-tetrahydrocannabinol (THC), a CB1 agonist which has a large affinity toward CB1 receptors but can also interact with CB2 as well. It is the acid form of THC, tetrahydrocannabinolic acid (THCA) that is actually produced by the Cannabis plant. Through either slow oxidation over time or through exposure to heat, THCA is decarboxylated to the more bioavailable and potent THC (Backes 2014). In addition to being a potent psychoactive substance, THC is also a strong anti-inflammatory and analgesic agent (Russo 2011). Additionally, THC is known to be a strong neuroprotective agent, and reduces intraocular pressure, muscle tension and spasticity (Hampston 1998) (Pacher 2006).

Another cannabinoid found in Cannabis is cannabidiol (CBD) which displays allosteric type interaction with CB1 and CB2 receptors, meaning that it does not bind to the primary receptor site. It may be involved in modulating how THC or other cannabinoids bind to CB1 and CB2 receptors (Ivker 2014). Like THC, CBD is the decarboxylated form of cannabidiolic acid (CBDA) which is produced by the Cannabis plant. Unlike THCA however, there is research indicating that CBDA is more bioavailable than CBD (Backes 2014). CBD also demonstrates anti-inflammatory and analgesic properties, and may be a potent anticonvulsant.

Cannabigerol (CBG) is the precursor molecule that forms both THC and CBD. There are only a few Cannabis varieties that produce a significant amount of CBG up to maturity. CBG is also currently being studied for use in treating inflammatory bowel disease (IBD). CBG is not psychoactive and also has analgesic properties. CBG may also be a useful antiseptic, antibiotic and possible anti-tumor agent (Backes 2014).

Cannabichromene is an uncommon cannabinoid produced by a few Cannabis varieties from Central Asia. It is produced more in the immature flower heads than the mature flower. It does not directly bind with cannabinoids receptors (Colasanti 1984). However, it does display anti-inflammatory and analgesic properties as well as possible anti-depressant effects in laboratory animals (Deyo 2003).

Referring to FIG. 1, a table of the common types of cannabinoids is provided, summarizing the physiological effect of THC, CBD, THCA, CBDA, CBG, and CBC.

Terpenes are often aromatic compounds, found in Cannabis but also many other plants, fruits, and vegetables. The terpenes in Cannabis give it the distinctive smells and flavors associated with different strains, as THC and CBD are both odorless and flavorless (Backes 2014). There are over 200 terpenes known to exist in various Cannabis strains (Backes 2014). Terpenes are physiologically active and psychologically active.

D-limonene is a terpene found in Cannabis, but also found in citrus fruits. It gives some strains of Cannabis a stimulating and mood-elevating properties, and has been shown to be helpful with heartburn, anxiety, and as an anti-microbial agent (Ivker 2015).

Myrcene is found in mangoes and hops as well as Cannabis and provides the sedative, muscle relaxing effects present in some strains of Cannabis. Myrcene has been described as a “potency multiplier”, as this terpene can help determine if a particular strain of Cannabis is going to be sedating or energizing. If it contains more than 0.5% of myrcene it most likely will be a sedating strain, and if less than 0.5% myrcene it will likely have an energizing effect (Ivker 2015).

Beta-caryophyllene is a terpene found in hops and black pepper. Since it is larger than many other terpene molecules, it typically survives extraction temperatures that smaller terpenes do not, and thus is a very common terpene to be found in Cannabis extracts. It is an effective anti-inflammatory when applied either internally and external. It may also prevent certain “foggy headed” side-effects of THC overuse (Russo 2011).

Linalool is found in lavender plants and is mildly psychoactive. It has anti-anxiety and calming effects on the patient. It too has analgesic and anesthetic qualities (Backes 2014).

The interplay between THC, CBD, and terpenes can greatly influence how a particular strain of Cannabis affect a patient's mind and body; it is this interplay that provides the typical effects of Cannabis indica or sativa (Russo 2011). Indica strains often have more of the terpenes, like myrcene, that are sedative and calming, while sativa strains usually are composed of activating and stimulating terpenes like d-limonene. It also this interplay that may account for clinical effects of whole Cannabis extract performing better as anti-convulsants than the synthesized pure THC or CBD counterpart (Russo 2011).

Referring to FIG. 2, a table of the common types of terpenes found in Cannabis is provided, along with their natural sources, and physiological effects.

The flowering body of the Cannabis plant, in Cannabis sativa, Cannabis ruderalis and Cannabis indica have analgesic properties. It has various names in Chinese Medicine, including mafen (

), and mabo (

), and mahua (

), all of which refer to the spike-shaped flower of the Cannabis plant. It is thought that the term “lightens the body” may refer to Cannabis's analgesic effects (Brand 2017). Additionally, in the Great Encyclopedia of Chinese Medicinals, it is stated that mafen “dispels wind, relieves pain, and settles tetany” (Editorial Committee 1977).

2. Compounds of the Disclosure

A composition combining Chinese herbal formulas along with Cannabis extract to deliver a unique composite effect for headache relief is provided herein. This custom herbal composition has been developed utilizing components from traditional Chinese herbal pharmacopeia as well as herbs with more contemporary evidence of analgesia for headaches. The composition also can contain herbs that, per Chinese herbal medicine theory, have a protective component against some of Cannabis's negative effects.

In one exemplary embodiment, the composition can include therapeutically effective amounts of Cannabis and the herbs Corydalis yanhusuo, Paeonia lactiflora, Ligusticum chuangxiong, Angelica dahurica, and Scutellaria baicalensis, wherein the therapeutically effective amounts ameliorate or prevent symptoms associated with headache. In some embodiments, the composition further can include the herbs Mentha Haplocalyx, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, and Lycium barbarum.

In some embodiments of the composition, the mass ratio of Corydalis yanhusuo:Paeonia lactiflora:Ligusticum chuangxion:Angelica dahurica:Scutellaria baicalensis:Mentha Haplocalyx:Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum can be about 12:12:12:6:8:24:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15. Stated another way, the mass ratio of Corydalis yanhusuo:Paeonia lactiflora:Ligusticum chuangxion:Angelica dahurica:Scutellaria baicalensis:Mentha Haplocalyx: Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum can be about 6:6:6:3:4:12:6:2.25:3:3: a value between 1 to 3:4.5:1.5:4.5:3:7.5.

In some embodiments of the composition, the Cannabis can be derived from an oil extract. The composition further can include herbs made of an aqueous ethanol extract of Corydalis yanhusuo, Paeonia lactiflora, Ligusticum chuangxiong, Angelica dahurica, and Scutellaria baicalensis, Mentha Haplocalyx, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, and Lycium barbarum. In further embodiments, the mass ratio of Corydalis yanhusuo:Paeonia lactiflora:Ligusticum chuangxion:Angelica dahurica:Scutellaria baicalensis:Mentha Haplocalyx:Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum: is about 12:12:12:6:8:24:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15, respectively. Or, stated another way, the mass ratio is about 6:6:6:3:4:12:6:2.25:3:3. The oil and aqueous ethanol extracts can be substantially free of solids. The composition further can include an emulsion of (a) the oil extract of the Cannabis and (b) the aqueous ethanol extract of the herbs.

In certain embodiments, the composition comprises from about 1 to about 100 mg of cannabinoids per mg of aqueous ethanol extract. In certain embodiments, the composition includes about 0.01 to 0.1 mg of Cannabis derived terpenes per mg of composition. Further embodiments of the composition include a mass ratio of THC:cannabidiol (CBD) between 2:1 to 10:1.

This composition can include many of the constituent herbs of Chuang Xiong Cha Tiao San, with the exclusion of Xi Xin. Xi Xin is known to contain aristolochic acid, which is known to be nephrotoxic (Yang 2014). Chuan Xiong Cha Tiao San is a formula that stops headache on any area of the head due to the inclusion of multiple “wind” herbs. Traditionally, Chuang Xiong (Ligusticum chuanxiong) clears wind and alleviates headaches along the temples and vertex of the head (Scheid 2007). Contemporarily, Chuang Xiong has been found to reduce nitric oxide (NO) and cyclooxygenase-2 (COX-2) inflammatory pathways in vitro (Liu 2017). Nitric oxide has been shown in studies to be a pro-nociceptive neurotransmitter, thus reducing formation of nitric oxide may be a potential therapeutic target for analgesic medications (Aley 1998).

Bo He (Mentha haplocalyx) benefits the head and eyes (Scheid 2007). Additionally, peppermint a member of the Mentha family has been shown to have positive relaxation effects on the gastrointestinal tract as well as analgesic and anesthetic effects in both the central and peripheral nervous system (Mckay 2006).

Bai Zhi (Angelica dahurica) treats frontal headache in Chinese medicine, and has also been shown to suppress NO, COX-2 and interleukin-1B pro-inflammatory pathways (Wang 2015).

Qiang Huo (Notopterygium incisum) treats occipital head pain in Chinese Medicine and has contemporarily been identified to inhibit nitric oxide production, which can lead to anti-inflammatory physiological effects (Blunder 2014).

Recent scientific studies have shown that Jing Jie (Schizonepeta tenuifolia) suppresses nitric oxide formation and tumor necrosis factor, as well as increases antioxidant activity (Wang 2012).

Fang feng, (Saposhnikovia divaricate) is another Chinese herb that can relieve muscle spasms (Benksy 2015). Components of Saposhnikovia divaricate have been found to have anti-nociceptive effects in animal models, by downregulating the expression of COX-2 enzyme (Wu 2016).

Gan cao (Glycyrrhiza uralensis) may be used to relieve muscle spasms and alleviate pain (Bensky 2015). The extract of Glycyrrhiza uralensis can also diminish the intensity of muscle spasms by inhibiting phosphorylation of Heat Shock Protein 27 (Yang 2017). The antispasmodic effects of Gan Cao can also be helpful in treating muscle tension.

Camellia sinensis, also known as green tea or cha ye, is a very common beverage in Asian countries and in traditional Chinese medicine it clears the head. Contemporarily, green tea has been shown to have antinociceptive effects in animal models of pain induction (Arzi 2013). One of the main antioxidants in green tea is epigallocatechingallate (EGCG), which has also been shown to anti-inflammatory and helpful for reducing neuropathic pain (Bimonte 2017).

Jin Yin Hua, Lonicera japonica, is traditionally indicated to clear heat and cool the blood and for “clearing-wind heat” (Bensky 2015). This herb may be included in the disclosed composition to help mitigate the warmer nature of Cannabis's TCM temperature. Contemporary research into Lonicera japonica extract has determined that it has anti-inflammatory and analgesic qualities, attributed to its ability to inhibit COX-2, nitric oxide synthase and 5-lipoxyfinase (Ryu 2010).

Deng Xin Cao, Juncus effuses can be included in presently disclosed compositions to help mitigate the potential for anxiety or tachycardia. Modern research has shown that extract of Juncus effuses has anti-inflammatory properties. It has been shown to reduce levels of pro-inflammatory chemical mediators, including nitric oxide, prostaglandin E2 and the cytokines IL-1B and IL-6 (Park 2016).

Yan hu suo, Corydalis yanhusuo, is among the strongest of pain relieving herbs in Traditional Chinese herbology. Traditionally, it is used to invigorate the blood, promote the movement of Qi and alleviate pain (Bensky 2015). When coupled with Chuan xiong, the headache relieving qualities of both herbs is synergized. Contemporary research has shown that some of the compounds in Yan Hu Suo induce antinociceptive activity by binding to D2 dopamine receptors (Zhang 2014). Additionally, formula preparations of Yan Hu Suo have been shown to have anti-aging properties as well an anxiolytic effects in laboratory animal models (Li 2017).

Man Jing Zi, Vitex trifolia, is traditionally used to clear wind and heat, especially when there is head or eye pain. Additionally, it clears and benefits the head and eyes, particularly along the Liver channel and for red, painful eyes. This herb is included in the presently disclosed compositions not only for the traditional pain relief indications, but also to mitigate against the drying and reddening nature Cannabis can have on the eyes. Current research indicates that extracts of Vitex have antinociceptive properties when used in laboratory animal models (Cheng 2010).

Tian ma, Gastrodia elata, is used in traditional Chinese Medicine to control and extinguish “Liver Wind.” This herb may be particularly useful for treating headaches caused by Liver wind (Bensky 2015). It harmonizes well with chuan xiong for the treatment of wind that leads to migraine and dizziness (Besnky 2015). It may lead to demonstrated reduction in allodynia and hyperalgesia in a rat model for peripheral neuropathy by using Gastrodia elata extract (Sun 2012). Additional research has shown that components of Gastrodia extract inhibit pain by decreasing spinal synaptic potentiation, a novel mechanism for pain modulation (Xiao 2017).

Huang Qin, Scutellaria baicalensis, is traditionally used as a Heat clearing herb in Traditional Chinese Medicine. Particularly, it sedates ascendant Liver Yang which can manifest as headache, red eyes and irritability (Bensky 2015). Contemporary research has demonstrated that extracts of Scutellaria baicalensi have an analgesic effect on acute pain in laborartory animal models (Yimam 2012). Scutellaria baicalensi extract may also exhibit analgesic and anti-inflammatory properties when used in a cancer pain study using laboratory animals (Hu 2015).

Gou Qi Zi, Lycium barbarum, is a tonifying herb that nourishes the Blood and Yin of the Kidney and Liver in Traditional Chinese Medicine theory. Cannabis is described in the Shen Nong Ben Cao Jing as having an acrid and dispersing effect, which is an ideal quality for a pain relieving agent (Bensky 2015). However, these qualities also mean that Cannabis can have a drying effect on different parts of the body. This can be seen in the dry, red eyes that sometimes develop after Cannabis dosing, as well as dry mouth. The incorporation of Gou Qi Zi into this formula is intended to counteract the drying effects of Cannabis. Contemporarily, Lycium barbarum has demonstrated anti-oxidant and anti-inflammatory properties (Nardi 2016). Furthermore, Lycium's anti-inflammatory properties may stem from inhibition of the pro-inflammatory NF-KB pathway (Phillippe 2012).

Finally, Bai Shao, Paeonia lactiflora, is traditionally also a tonifying herb. It nourishes the Blood as well calms ascendant “Liver Yang.” This herb is traditionally used with Gan Cao Glycyrrhizae radix, to alleviate muscle spasms and head pain (Bensky 2015). Modern research shows that extracts of Paeonia lactiflora have anti-inflammatory and immunomodulatory effects that can suppress pain producing cytokines like prostaglandin E2, leukotriene B4 and nitric oxide (He 2011). Additionally, chemical components of Paeonia lactiflora extract have been shown to attenuate neuropathic pain by inhibiting the pro-inflammatory mitogen-activated protein kinase (MAPK) pathway (Zhou 2016).

Referring now to FIG. 3, a list of constituent herbs included in some embodiments of the composition is provided. Included for each herb is the standard species name, English common name, the pharmaceutical name, pinyin, and the content in grams.

3. Methods of Making

A method of forming a composition including Cannabis and two or more herbs selected from the group consisting of Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and combinations thereof, is also provided. The method can include: i) extracting the Cannabis with oil, ii) extracting the two or more herbs with aqueous ethanol, and iii) emulsifying the Cannabis extract with the extract of the two or more herbs.

Referring to FIG. 4, Cannabis can be extracted using oil and solids filtered off. Herbal blends may be extracted using aqueous ethanol and solids filtered off. The two extracts may be emulsified to create a final combined composition.

In some embodiments, the two or more herbs can be extracted with aqueous ethanol in a mass ratio of about 12:8:12:24:6:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15 for Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, respectively.

In some embodiments, the Cannabis can be a hybrid of Cannabis sativa and Cannabis indica. In certain embodiments of the method, the Cannabis oil can be extracted by immersing the Cannabis in oil for about 6 to about 10 hours, and removing solids to form the extract. In some embodiments, extraction also can occur by immersing the Cannabis in oil. About 3.3 to about 4.5 mL of oil may be used per gram of Cannabis.

In some embodiments, the herbs can be extracted by immersing them in aqueous ethanol for about 12 hours to about 36 hours, or any range including or up to those two times, and removing solids to form the extract. In some embodiments of the extraction, about 0.5 mL to about 2 mL of aqueous ethanol can be used per gram of the two or more herbs. The aqueous ethanol can be from about 40 to about 60 v/v % ethanol.

In certain embodiments, from about 1 mL to about 100 mL of Cannabis extract with about 100 mL to about 200 mL of the herbal extract can be emulsified together. The emulsifying may be achieved through sonication.

4. Methods of Use

A method of treating or preventing a headache symptom in a subject in need thereof is also provided herein. The method can include administering to a subject a therapeutically effective amount of a composition made of an emulsification of (a) an oil extract of Cannabis and (b) an aqueous extract of two or more herbs selected from the group consisting of Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and combinations thereof.

In some embodiments, the two or more herbs can be extracted with aqueous ethanol in a mass ratio of about 12:8:12:24:6:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15 for Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, respectively. The aqueous ethanol extract can be a blend of the herbs.

EXAMPLES

A multi-center clinical trial in an outpatient setting was performed. The study protocol was reviewed for approval by the California Institute for Integrative Studies Human Research Review Committee and Institutional Review Boards Ethics Committees from research facilities. Patients were recruited by participating medical providers at an academic or clinical setting. institutions, as well as by approved ads in news outlets, paper flyers, and on social media, following inclusion and exclusion criteria summarized below. After consenting to participation, participants were asked to complete demographic questionnaires, as well as document headache and health history. A medical doctor conducted an intake exam and interview. Three hundred participants were recruited for this study, with fifty participants in each group.

Inclusion criteria include having a tension type headache as defined by the International Headache Society. Participants were selected if they had headaches lasting from 30 minutes to 7 days, and had those headaches less than 180 days per year or 15 per month, Furthermore, those headaches must have had at least two of the following pain characteristics: pressing or tightening (non-pulsating) quality, mild to moderate intensity (does not completely incapacitate the patient), bilateral location on the head, not exacerbated or aggravated by walking up stairs or any similar routine physical activities.

Exclusion Criteria

As part of International Headache Society guidelines for tension type headache definitions, prospective study participants were excluded if they had nausea or vomiting accompanying their headaches. Also, prospective participants could only present with photophobia (sensitivity to light) or phonophobia (sensitivity to sound), but not both. Presence of either photophobia or phonophobia was a not a requirement for the study. Other exclusion criteria include: those study applicants having had tension type headaches for less than one year, diagnosed abnormal liver and kidney function, systemic disease, abnormal neurological assessments, applicants currently on prescription triptan-type medications for the treatment for headaches (outside of symptomatic analgesics), hypertension, pregnant women or those seeking to become pregnant, the presence of an organic cause such as a brain tumor, or liver or kidney disease, and persons under the age of 21.

The random control trial included four arms:

-   -   1. Control group, consisting of vehicle groups for each separate         treatment. (n=150)         -   a. Alcohol/water vehicle group (n=50)         -   b. Olive oil group (n=50)         -   c. Alcohol/water/olive oil (n=50)     -   2. Custom Chinese herbal formula alone group (n=50),     -   3. Cannabis alone group (n=50), and the     -   4. Combination Chinese herbal plus Cannabis group (n=50).

All groups were randomized by assigning each participant an automatically generated number randomized by software. Each group had the same number of participants. The control group preparation contained only the vehicle for administration. The vehicle is the substrate with which the herbs and Cannabis are mixed in. For example, the Chinese herbs were suspended in a mixture of 50% ethanol and 50% water. Ethanol and water, in a 1:1 ratio, is therefore the Chinese herbal groups vehicle. The Cannabis group was olive oil, water, and an emulsifying agent; sunflower lecithin. The components of the liquid vehicle, Chinese herbal preparation, Cannabis preparation and the combination preparation were all be single lot preparation. All herbal preparations were from the same lot of Chinese herbal formulas and Cannabis and were composed from the same lots and manufacturers. These formulations were all tested for contaminants, heavy metals, pesticides and herbicides. A certificate of analysis was kept of file. Participants were allowed to continue symptomatic pharmaceutical analgesics as needed for headache pain, but were asked to record use of these medicines. The study was completed using intent-to-treat.

Treatment lasted for 8 weeks. During treatment, there were 0, 2, 4 and 8-week time points where patients were asked to complete questionnaires regarding: headache frequency, report on intensity of each headache using Visual Analog Pain scale, and report on medication use (i.e. OTC analgesics). The pain scale incorporated into these questionnaires was the Visual Analog Scale (FIG. 5). This pain scale uses a printout of a scale of exactly 100 mm long, with “no pain” and “most pain” at both extremes of the scale. The patient is asked to place a mark on the scale to indicate where their pain is currently. This mark is then measured and quantified. Additionally, the participants were asked how many doses and total volume the patients took for each headache episode. The various time point interviews were used to discuss any side effects or adverse events that any of the study participants experienced. Participants were also able to ask for more of any of the treatments they used in the study. Patients were asked to keep a log regarding their use of both experimental treatment medication and any over-the-counter medication they needed to use if pain level was not reduced enough by the experimental treatment.

Following end of treatment, there were follow up interviews at 4, and 8 weeks post-treatment cessation, to see how long symptom attenuation, if any, persisted. These post-treatment evaluations were also used to discuss any side effects or adverse events that any of the study participants experienced. After the 8-week post treatment interview and data gathering, patients were dismissed from the study.

Study groups were compared using X² analysis and paired t-tests using SPSS, version 25. Adverse events were calculated by the quantitative method of Mastroianni et al. (Mastroinanni, 2017).

The study employed Resman Research Management (RRMS) software to manage the trial data. The participants in the trial were randomized by RRMS software. Participants that fulfilled the inclusion criteria were randomly allocated into one of the four treatment groups, with the desired end goal of equal distribution to all four groups. The RRMS software created unique identification codes for each participant. Prior to the study commencing, all involved researchers received training in allocation concealment. Randomization and allocation were managed and password-controlled in the RRMS software by a pre-designated member of the research team. This person was not involved in the direct screening or enrolling of participants. Screeners, and enrollers, and statisticians were blinded to the identification of each participant (Li 2017).

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What is claimed:
 1. A composition comprising therapeutically effective amounts of Cannabis and the herbs Corydalis yanhusuo, Paeonia lactiflora, Ligusticum chuangxiong, Angelica dahurica, and Scutellaria baicalensis, wherein the therapeutically effective amounts ameliorate or prevent symptoms associated with headache.
 2. The composition of claim 1, wherein the composition further comprises the herbs Mentha Haplocalyx, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, and Lycium barbarum, and wherein the mass ratio of Corydalis yanhusuo:Paeonia lactiflora:Ligusticum chuangxion:Angelica dahurica:Scutellaria baicalensis:Mentha Haplocalyx:Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum is about 12:12:12:6:8:24:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15.
 3. The composition of claim 2, wherein the Cannabis comprises an oil extract of the Cannabis.
 4. The composition of claim 3, wherein the herbs comprise an aqueous ethanol extract of Corydalis yanhusuo, Paeonia lactiflora, Ligusticum chuangxiong, Angelica dahurica, and Scutellaria baicalensis, Mentha Haplocalyx, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, and Lycium barbarum, wherein a mass ratio of Corydalis yanhusuo:Paeonia lactiflora:Ligusticum chuangxion:Angelica dahurica:Scutellaria baicalensis:Mentha Haplocalyx:Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum: is about 12:12:12:6:8:24:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15; and wherein the oil and aqueous ethanol extracts are substantially free of solids.
 5. The composition of claim 4, wherein the composition comprises an emulsion of (a) the oil extract of the Cannabis and (b) the aqueous ethanol extract of the herbs.
 6. The composition of claim 4, wherein the composition comprises from about 1 to about 100 mg of cannabinoids per mg of aqueous ethanol extract.
 7. The composition of claim 4, comprising about 0.01 to 0.1 mg of Cannabis derived terpenes per mg of composition.
 8. The composition of claim 4, comprising a mass ratio of THC:cannabidiol (CBD) between 2:1 to 10:1.
 9. A method of forming a composition comprising Cannabis and two or more herbs selected from the group consisting of Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and combinations thereof, the method comprising: extracting the Cannabis with oil, extracting the two or more herbs with aqueous ethanol, and emulsifying the Cannabis extract with the extract of the two or more herbs.
 10. The method of claim 9, wherein two or more herbs comprise Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and further wherein the herbs are extracted with aqueous ethanol in a mass ratio comprising about 12:8:12:24:6:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15 for Corydalis yanhusuo:Scutellaria baicalensis:Ligusticum chuangxion:Mentha Haplocalyx:Angelica dahurica: Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum:Paeonia lactiflora, respectively.
 11. The method of claim 9, wherein the Cannabis comprises a hybrid of Cannabis sativa and Cannabis indica.
 12. The method of claim 9, wherein extracting the Cannabis with oil comprises immersing the Cannabis in oil for about 6 to about 10 hours, and removing solids to form the extract.
 13. The method of claim 9, wherein extracting the Cannabis with oil comprises immersing the Cannabis in oil, wherein about 3.3 to about 4.5 mL of oil is used per g of Cannabis.
 14. The method of claim 9, wherein extracting the herbs with aqueous ethanol comprises immersing the herbs in aqueous ethanol for about 12 to about 36 hours, and removing solids to form the extract.
 15. The method of claim 9, wherein extracting the herbs with aqueous ethanol comprises immersing the herbs in aqueous ethanol, wherein about 0.5 mL to about 2 mL of aqueous ethanol is used per gram of the two or more herbs.
 16. The method of claim 9, wherein the aqueous ethanol comprises from about 40 to about 60 v/v % ethanol.
 17. The method of claim 9, wherein emulsifying comprises emulsifying from about 1 to about 100 mL of Cannabis extract with about 100 to about 200 mL of the extract of the two or more herbs.
 18. The method of claim 9, wherein the emulsifying comprises sonication.
 19. A method of treating or preventing a headache symptom in a subject in need thereof, comprising administering to the subject a therapeutically effective amount of a composition comprising an emulsification of (a) an oil extract of Cannabis and (b) an aqueous extract of two or more herbs selected from the group consisting of Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong, Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and combinations thereof.
 20. The method of claim 19, wherein two or more herbs comprise Corydalis yanhusuo, Scutellaria baicalensis, Ligusticum chuangxiong Mentha Haplocalyx, Angelica dahurica, Notopterygium incisum, Schizonepeta tenuifolia, Saposhnikovia divaricate, Glycyrrhiza uralensis, Camellia sinensis, Lonicera japonica, Juncus effuses, Vitex trifolia, Gastrodia elata, Lycium barbarum, and Paeonia lactiflora, and wherein the aquous ethanol extract is an extract of a blend of the herbs compring a mass ratio of Corydalis yanhusuo:Scutellaria baicalensis:Ligusticum chuangxion:Mentha Haplocalyx:Angelica dahurica:Notopterygium incisum:Schizonepeta tenuifolia:Saposhnikovia divaricate:Glycyrrhiza uralensis:Camellia sinensis:Lonicera japonica:Juncus effuses:Vitex trifolia:Gastrodia elata:Lycium barbarum:Paeonia lactiflora of about 12:8:12:24:6:12:4.5:6:6: a value between 2 to 6:9:3:9:6:15. 